Abstract
Purpose: Early results of MI treatment of proximal humeral fractures in mainly osteoporotic bone stock using the NCB®-PH plate showed promising results reaching 62 points (86% of age related normal value) in Constant Score 6 months postoperatively (Roederer et al., submitted, 2006). The purpose of this study was to analyze the long-term results focusing on functional outcome and complications.
Methods: So far out of a total number of 90 cases we have gained the data of 35 patients (24 women, 11 men; age 68 in the mean) who sustained fractures of the proximal humerus treated MI with the NCB-PH® plate (Zimmer Company, Winterthur, Switzerland). In 16 cases (46%) osteoporosis has been diagnosed pre-operatively. Radiological follow-up in two planes and functional outcome is assessed clinically (ROM) and using visual analogue scale (VAS) for pain and function, Constant Score and a modified adl score (activities of daily living).
Results: Average ROM (in degree) for anteversion was 101, glenohumeral abduction 87, external rotation 31 and internal rotation 81. Average VAS for pain was 1, 9 points (10 = worst) and for function 6, 4 points (10 = best). Average Constant Score was 65 points, average adl score was 16 points (30 = best). Between 6 and 12 months postoperatively one case (2, 9%) of sintering of the humeral head and one case (2, 9%) of avascular necrosis was detected. In 3 cases (9%) of reversed impingement we performed total removal of hardware. Four younger patients (11%; age 60 in the average) underwent the same procedure demanding it though not suffering of limited ROM or pain.
Conclusion and Significance: In the early results NCB-PH® proved to be an effective MI method of treatment of fractures of the humeral head in the elderly patient with mainly osteoporotic bone stock. The 1 year follow up data show further functional improvement (approx. 5% of Constant Score). The complication rate remains low (5/35 = 14%).
Especially, no cases of lesions of the axillary nerve or frozen shoulder were seen. The latter we believe is due to the MI procedure and the early functional treatment due to high primary stability of the NCB-PH® plate. Despite good functional outcome, younger patients with higher levels of activity compared to the average patient sustaining proximal humeral fractures tend to feel subjective problems with the plate in situ demanding surgical removal of hardware. The long-term results also prove the NCB-PH® plate to be a safe and effective method of treatment reaching a functional outcome that enables the mostly old patients to regain an acceptable level of activity. Removal of hardware is easy to perform and offers especially in the younger patient a possibility to at least improve patients’ subjective outcome
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
